Lifting Heavy and Your Pelvic Floor: Building Strength Without Fear
Women are often told that lifting heavy will weaken the pelvic floor, worsen prolapse, or cause leakage. The evidence is more nuanced than that, and the goal is not to avoid load. It is to build the capacity to manage it.
Strength training is increasingly recognised as an important part of long term health. It helps us maintain muscle, develop strength and power, and preserve our ability to perform everyday tasks as we age. For women in particular, maintaining strength becomes increasingly important through pregnancy, postpartum recovery, perimenopause, menopause and later life.
Yet when pelvic floor health enters the conversation, heavy lifting is often approached with caution. Women may be told that lifting heavy weights will weaken the pelvic floor, worsen prolapse or cause urinary leakage.
The evidence is more nuanced.
Heavy lifting does increase the demand placed on the pelvic floor, but increased demand is not automatically the same as damage. Current research suggests that appropriately prescribed resistance training can be compatible with good pelvic floor health, and in some situations may form part of the rehabilitation process.
The goal therefore should not simply be to avoid load. It should be to develop the strength, coordination and capacity required to manage it.
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What do current strength training guidelines recommend?
Australia's updated 2026 24-Hour Movement Guidelines recommend that adults perform muscle strengthening activities at moderate or greater intensity, involving all major muscle groups, on at least two days each week. Lifting weights is specifically included as a form of muscle strengthening activity.
For people specifically wanting to become stronger, the latest American College of Sports Medicine (ACSM) Position Stand, published in 2026, provides more detail. After reviewing 137 systematic reviews involving more than 30,000 participants, ACSM concluded that resistance training improves strength, muscle size, power, muscular endurance and multiple measures of physical function.
For maximising strength, the evidence favoured:
Load
Heavier loads of approximately 80% of one repetition maximum (1RM) or greater.
Frequency
Training at least twice per week.
Volume
Approximately 2 to 3 sets per exercise.
Execution
Training through an appropriate full range of motion, with priority strength exercises performed earlier in the session.
Heavy is relative
Eighty per cent of 1RM simply means a resistance that is heavy for that individual. It does not mean that every woman should be squatting or deadlifting a particular number of kilograms.
The ACSM review also found that very heavy weights are not essential for building muscle. A broad range of loads can produce muscle growth when sufficient training volume and effort are provided. Heavy resistance becomes particularly useful when the goal is to improve maximal strength.
So from a general health and strength perspective, there are good reasons to progressively challenge our muscles. But what happens to the pelvic floor when we do?
Your pelvic floor is part of the lifting system
The pelvic floor is a group of muscles and connective tissues forming the base of the pelvis. It contributes to bladder and bowel control, supports the pelvic organs, and works alongside the diaphragm and the abdominal and spinal muscles during movement.
When you squat, deadlift, push or pull a challenging weight, pressure inside the abdomen increases. Historically, this increase in intra abdominal pressure has contributed to the concern that heavy lifting may damage the pelvic floor or increase the likelihood of pelvic organ prolapse. NICE (National Institute for Health and Care Excellence) acknowledges that heavy lifting has traditionally been considered a pelvic floor risk because of this increased pressure.
But pressure itself is not necessarily the problem. The pelvic floor is designed to respond to changes in pressure. The more relevant question is whether the pelvic floor and the surrounding system have enough strength, endurance, coordination and recovery capacity to repeatedly manage the demands being placed on them.
This is where the emerging research becomes particularly interesting.
Forner, Beckman and Smith · 2020
Does heavy lifting cause pelvic organ prolapse?
One of the three studies examining this question directly surveyed women who either did not lift weights, or regularly lifted light weights of 15 kg or less, moderate weights of 16 to 50 kg, or heavy weights above 50 kg.
If heavier resistance automatically damaged the pelvic floor, we might expect prolapse symptoms to become progressively more common as lifting loads increase. That was not what the researchers found. Women who lifted more than 50 kg did not report a greater prevalence of pelvic organ prolapse symptoms. In fact, women lifting lighter weights reported more symptoms than those in the heaviest lifting category.
That does not automatically mean heavy lifting protects against prolapse. It does challenge the simple assumption that more weight equals more pelvic floor damage.
Virtuoso, Menezes and Mazo · 2019
Can strength training help with urinary leakage?
Potentially. This randomised controlled trial studied 26 older women experiencing stress urinary incontinence. One group performed pelvic floor muscle training alone. The other combined pelvic floor muscle training with moderate intensity weight training twice per week for 12 weeks.
Women experiencing urinary leakage do not necessarily need to avoid resistance training. When appropriately programmed, whole body strength training may be incorporated alongside targeted pelvic floor rehabilitation. This research was significant enough for NICE to acknowledge that newer evidence suggested weight training combined with pelvic floor muscle training could improve urinary incontinence symptoms.
58% vs 15%
After four weeks, roughly 58% of women in the combined strength and pelvic floor training group were symptom free, compared with around 15% of those performing pelvic floor training alone.
Menezes and colleagues · 2024
Resistance training changes pelvic floor function, but not always in the same way
Seventeen older women without diagnosed pelvic floor disorders were divided into resistance training, resistance training combined with deliberate pelvic floor contractions, or a control group.
Following resistance exercise, pelvic floor maximum voluntary contraction, or the highest voluntary force achieved, improved acutely in the resistance training only group. Women who consciously coordinated pelvic floor contractions with their resistance exercises demonstrated an improvement in bladder neck angle.
After 12 weeks, however, pelvic floor contraction endurance, meaning its ability to hold a contraction over a longer duration or repeat contractions, decreased in both resistance training groups. This was a small feasibility study and broad conclusions cannot be drawn from it, but it illustrates an important point.
Pelvic floor function is more complex than simply being strong or weak.
Doing more Kegels, or applying a one size fits all exercise prescription, is therefore not the answer. A pelvic floor needs to generate force when required, sustain contractions when necessary, and just as much, relax and coordinate appropriately with breathing and movement.
What about breathing and bracing when lifting?
Breathing deserves some nuance too. You may have heard that women should always breathe out while lifting, or should not hold their breath, to protect the pelvic floor.
Exhaling through the difficult part of an exercise can be a useful strategy, particularly when learning to coordinate the pelvic floor or when managing symptoms. But there is not one breathing strategy that needs to be applied to every person and every lift.
As loads become heavier, lifters naturally increase abdominal and trunk stiffness to stabilise the spine. How much bracing is appropriate will depend on the load, the experience of the lifter, the symptoms present, and individual pelvic floor function.
Instead of focusing solely on avoiding pressure, the aim should be to develop the capacity to appropriately generate, manage and release pressure.
For some women this may involve learning to coordinate a pelvic floor contraction with lifting. For others, particularly those with an overactive or high tone pelvic floor, constantly contracting harder may actually be counterproductive. Individual assessment becomes important when symptoms are present.
When your pelvic floor is telling you the load is too much
Pelvic floor symptoms during strength training should not simply be accepted as an unavoidable part of exercising, ageing or having children.
Symptoms worth paying attention to
- Urinary or bowel leakage
- Vaginal heaviness or dragging
- A sensation of bulging or pressure
- Pelvic or vaginal pain
- Difficulty emptying the bladder or bowel
- Symptoms that progressively increase throughout a workout
- Symptoms that remain noticeably worse after training
These symptoms do not necessarily mean that you must stop strength training. They indicate that the current demand may be greater than your current capacity, and that something may need to change.
That could mean adjusting the weight, repetitions, exercise selection, lifting technique, breathing strategy, fatigue level or overall training volume, while simultaneously improving pelvic floor function.
The takeaway
Heavy strength training and pelvic floor health do not need to be opposing goals.
The current evidence does not support the idea that every woman should avoid heavy weights to protect her pelvic floor. One large observational study found no increased prevalence of prolapse symptoms among women lifting the heaviest weights, while smaller clinical trials suggest that resistance training can potentially complement pelvic floor rehabilitation.
At the same time, the pelvic floor specific research remains relatively small, and it does not justify telling every woman with symptoms to simply lift heavier. The better approach lies between these two extremes.
Where that leaves you
Build strength. Progress gradually. Train the pelvic floor according to its individual needs. Monitor symptoms. And modify the program when the body's current capacity does not match the demand.
Pelvic floor health should not be about making women afraid of load. It should be about developing the capacity to confidently manage it.
Work out what is actually going on
If you are lifting with symptoms, or you have stopped lifting because of them, an assessment is the step that tells you which of those adjustments you actually need. Our women's health exercise physiologists work in a supportive, non judgemental environment across both clinics. No referral is required to book.
Navneet Mahajan
Exercise Physiologist · Norwest
Women's health, pelvic health, and chronic condition management. Certified Pregnancy and Postpartum Corrective Exercise Specialist.
Book with NavMaddie Hamilton
Exercise Physiologist · Sydney CBD
Women's health, pelvic health, and pre and postpartum exercise prescription at our Sydney CBD clinic.
Book with MaddieNot sure whether we are the right fit? Nav offers a free 10 minute discovery call. Ten minutes, no assessment, no commitment.
Related reading
- Pelvic floor dysfunction: more than weakness
- A lifespan approach to pelvic floor health
- Incontinence in the female athlete
- The benefits of training during pregnancy
References
- Australian Government Department of Health, Disability and Ageing. (2026). Australian 24-Hour Movement Guidelines for Adults (18 to 64 years) and Older Adults (65+ years).
- Currier, B. S., D'Souza, A. C., Fiatarone Singh, M. A., et al. (2026). American College of Sports Medicine Position Stand: Resistance training prescription for muscle function, hypertrophy, and physical performance in healthy adults, an overview of reviews. Medicine & Science in Sports & Exercise, 58(4), 851 to 872.
- Forner, L. B., Beckman, E. M., & Smith, M. D. (2020). Symptoms of pelvic organ prolapse in women who lift heavy weights for exercise: a cross-sectional survey. International Urogynecology Journal, 31(8), 1551 to 1558.
- Menezes, E. C., Porto, R. M., Iwersen, B. P. R., Fank, F., Pereira, F. S., & Mazo, G. Z. (2024). Acute and chronic effect of resistance training on pelvic floor muscle morphology and function in older women: a clinical trial. Movement & Sport Sciences, 124, 1 to 11.
- National Institute for Health and Care Excellence. (2019). Urinary incontinence and pelvic organ prolapse in women: management (NG123).
- National Institute for Health and Care Excellence. (2021). Pelvic floor dysfunction: prevention and non-surgical management (NG210).
- Virtuoso, J. F., Menezes, E. C., & Mazo, G. Z. (2019). Effect of weight training with pelvic floor muscle training in elderly women with urinary incontinence. Research Quarterly for Exercise and Sport, 90(2), 141 to 150.
This article is general education, not individual medical advice. It cannot account for your history, symptoms, or any conditions you may have, and it is not a substitute for assessment by a qualified health practitioner. Outcomes vary between individuals. If you have symptoms that concern you, speak with your GP or book an assessment with an appropriately qualified practitioner before starting a new exercise program.